Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation.
Value Health
; 23(3): 309-318, 2020 03.
Article
in En
| MEDLINE
| ID: mdl-32197726
ABSTRACT
BACKGROUND:
Despite potentially severe and fatal outcomes, recent studies of solid organ transplant (SOT) recipients in Europe suggest that hepatitis E virus (HEV) infection is underdiagnosed, with a prevalence of active infection of up to 4.4%.OBJECTIVES:
To determine the cost-effectiveness of introducing routine screening for HEV infection in SOT recipients in the UK.METHODS:
A Markov cohort model was developed to evaluate the cost-utility of 4 HEV screening options over the lifetime of 1000 SOT recipients. The current baseline of nonsystematic testing was compared with annual screening of all patients by polymerase chain reaction (PCR; strategy A) or HEV-antigen (HEV-Ag) detection (strategy B) and selective screening of patients who have a raised alanine aminotransferase (ALT) value by PCR (strategy C) or HEV-Ag (strategy D). The primary outcome was the incremental cost per quality-adjusted life-year (QALY). We adopted the National Health Service (NHS) perspective and discounted future costs and benefits at 3.5%.RESULTS:
At a willingness-to-pay of £20 000/QALY gained, systematic screening of SOT patients by any method (strategy A-D) had a high probability (77.9%) of being cost-effective. Among screening strategies, strategy D is optimal and expected to be cost-saving to the NHS; if only PCR testing strategies are considered, then strategy C becomes cost-effective (£660/QALY). These findings were robust against a wide range of sensitivity and scenario analyses.CONCLUSIONS:
Our model showed that routine screening for HEV in SOT patients is very likely to be cost-effective in the UK, particularly in patients presenting with an abnormal alanine aminotransferase.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
State Medicine
/
Mass Screening
/
Organ Transplantation
/
Hepatitis E
/
Health Care Costs
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Health_economic_evaluation
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Aspects:
Patient_preference
Limits:
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
Value Health
Journal subject:
FARMACOLOGIA
Year:
2020
Document type:
Article